Do you transport or not?

[Just Plain Ruff]

great response Spenac

every place I've worked except for one said transport regardless of necessity. Keeps the legal eagles at bay. Plus one maybe just one will pay and it will offset some of the losses.

two places I've worked it wasnt' really an issue since we were based at the hospital that they were going to go to anyway so either way we were going back to the hospital so no foul there, plus we always had a 2nd ambulance as well as sometimes a third available to go get the really sick ones.

the one service where I worked that you could call medical control to get a refusal to transport authorized by the medical control doc and our refusing to transport happened so rarely that it was almost like a Holy cow you got the doc to do that kind of mentality when it happened. ON the flip side, for that particular service, if we had a patient refusal we had to call medical control to get permission to let the patient refuse. Many times medical control overrode the patient refusal when psych or mental deficiency came in to play.

All the other services were - transport the patient no matter what the complaint because we are not doc's we are EMT's and Medics and we don't have the medical training and malpractice insurance and schooling to back up refusing to transport.

That's the services I've worked for and their MO's

Did that clarify my position.

[JakeEMTP]

This scenario is reminiscent of a call we had last week. We transported a female pt to the ED at approximately 23:00. At 03:00 we were called back to the same residence. UOA, we were confronted by the pt's rather inebriated spouse. He informed us that he didn't require any medical attention, just a ride to the hospital from us since we had transported his wife earlier. When he was informed that we didn't provide such a service, he became somewhat agitated :wink: . At this time, LEO was called to assist. When we departed, PD was explaining to him the proper use of the 911 emergency system.

[spenac]

First Ruff thanks thats the input I'm looking for. I have never worked out of the sticks. The biggest city I worked in was about 25000 with a nice hospital and that was a long time ago just for a weeks worth of clinical ride outs. I see your point already going there so no big deal taking them back with you. Also probably lot more work to deny transport paper wise. For us lot more paper work and a lot more risk but we remain for the community and paperwork still quicker than 4 hours. As stated elsewhere we still usually take almost every patient that asks. Before we deny we first try to reason with patients and some will agree to see their own Doctor or ride with family, etc. The ones that don't reason then we have the procedures in place to look at denying them.

Ruff thank you for the insight into your area.

Now Jake feel you man. We had a lady that we had agreed to take to the hospital as we were finishing loading her, her husband came over and said he would be waiting for us to bring her home as he was going to be to busy working his goats to go get her. We explained that we are unable to bring people back home per protocol, and he was ready to fight. We eventually just had to get in the ambulance and leave. He eventually went and got her I guess because we've gone and transported her several times since. He's never gotten rude with us again.

[ALERT Medic]

I guess I'm confused a bit.

First off, call the police.

Second, call the supervisor.

Third, inform this wacho that you are not a taxi and since he doesn't have a medical complaint and will not allow you to do your job, you're not transporting him.

Simple as that.

I agree with Ruff, you're making a mountain out of a mole hill with this scenario. I know we have some people in our profession that aren't that blessed with a huge amount of common sense but give everyone a little credit. Not one of us likes people to just assume ownership of our rigs and I don't think for a second that I'm not gonna get in this persons face and inform them that they do not enter our unit without talking to us and that they are to exit the truck unless they have a medical complaint and then you wait for the police to arrive.

Which brings me to a whole different point: Stage for police to arrive on scenes like this. Very little information and basically a 911 hang up call, who are you to say that the scene is safe to even approach at this time. I'm going to respond but while I check enroute, request police to respond and inform dispatch that I'll be staging at a safe distance until someone can ensure that this isn't something that will get me or my partner hurt or worse.

Just my $.02

[Dustdevil]

We don't lock up here either and one of these days because of it we'll probably watch our unit going over the bridge into Mexico...

Theft is less than half of the concern. The major portion of the concern is for the safety of the crew and patients. That is why I say ALL doors are locked at ALL times. Not just when you park it and leave it. Nobody is going to open a door on my unit while I am in it OR if I am out of it.

...but hey I don't set the policy. I have recommended to start locking up or at least shutting down and taking the keys if we're out but got no for answer so far.

You need an official written policy to make you do the right thing? Unless it is a violation of written policy to lock your vehicle, why would you not just do it without having to be led by the hand?

[spenac]

Theft is less than half of the concern. The major portion of the concern is for the safety of the crew and patients. That is why I say ALL doors are locked at ALL times. Not just when you park it and leave it. Nobody is going to open a door on my unit while I am in it OR if I am out of it.

You need an official written policy to make you do the right thing? Unless it is a violation of written policy to lock your vehicle, why would you not just do it without having to be led by the hand?

The people in charge want the ambulance unlocked and running on seen. The only reason given is to avoid delays in getting equipment and to avoid having it not restart. My response it's going to be a much bigger delay waiting for a new ambulance to come in. Again working to change bad habits of the old timers here including myself.

[PRPGfirerescuetech]

1. Hypoglycemia

2. Psychiatric

3. Head trauma

4. altered mentation of unknown origin

5. CVA or head bleed with an odd presentation

6. Goofy old man looking for a ride.

These are the first 6 possibilities that cross my mind. He likely is just looking for a ride, but he could be a goofy old guy who isnt telling you everything.

Again, hes requesting a service, so you take him. I would politely remind him that his insurance wont cover the bill, and make sure he understands this ride is on him. As long as he knows that, then why not?

[spenac]

1. Hypoglycemia

2. Psychiatric

3. Head trauma

4. altered mentation of unknown origin

5. CVA or head bleed with an odd presentation

6. Goofy old man looking for a ride.

These are the first 6 possibilities that cross my mind. He likely is just looking for a ride, but he could be a goofy old guy who isnt telling you everything.

Again, hes requesting a service, so you take him. I would politely remind him that his insurance wont cover the bill, and make sure he understands this ride is on him. As long as he knows that, then why not?

In this scenario 6 is closest to right. But like you say in real world people sometimes leave a lot out when they talk to us.

I saw a form once and wish I could have gotten a copy of it but it stated something along the lines of what you verbally told him of insurance not paying, etc. Had an area where medics could put aprox cost of transport and seems like even asked something about deposit paid. Do not think it required deposit but guess it was there to put the idea in peoples minds. Then they signed it as well. I may have to design one as best I can and put it in English and Spanish then it by the lawyer to make sure don't violate any rights or laws.

[dahlio]

First thing I would do would be to explain to her, if possible, why calling 911 for a taxi is not the proper use of the system. If she comes more and more agitated, and demands she goes, I'll call police to take care of it. Playing the guilt trip is also an option. Telling her that someone could die while you're taking her to the hospital, and the ambulance won't get there on time. I remember one call that we had to do that on, where she wouldn't sign the RMA, and there was no one else there. The guilt thing usually works, and if it doesn't, then maybe there is something wrong with them...mentally.

[JPINFV]

My views on this.

1. I am not billing. I am employed to evaluate, treat, and transport as needed. The closest I care about billing is getting the person's RN to sign the physician's certificate of necessity paper for medicare.

2. My area has at 7 well established ambulance companies, at least one up and coming company, and several other companies just outside the area that can easily find their way down here. We aren't hurting for ambulances either for interfacility or for 911 transport. Transport times are short to the hospital in most cases. In the end, it would be much easier to just transport and get it done with.

THAT SAID, I've been on one call where we transported because fire refused to let the contracted 911 BLS crew transport a patient WITH a complaint (fall secondary to dizzyness if I remember correctly) to a hospital about 10 minutes farther away than the closest hospital (that was about 5 minutes away). They were told to call a private company. That gem occured at an assisted living place [no RNs] for Alzheimer's patients.